Tuesday, July 14, 2009

Alternative Birthing Options


One of my local television networks has aired a story about Alternative Birthing Options. It's a brief article, but pretty good. I think it's good for this information to be presented to the public and help people see that they have options other than the standard norm.

Information/education = informed choice = empowerment

Saturday, July 11, 2009

Genetic Testing During Pregnancy

I recently found this article about prenatal genetic testing. I feel everyone should know about prenatal tests, risks and benefits, and who the tests are recommended for. Your prenatal care provider can help you with this, and there are really good books available that will help you educate yourself to make an informed choice. Some of my favorite books on the subject include "The Thinking Woman's Guide to a Better Birth" by Henci Goer and "Pregnancy, Childbirth, and the Newborn" by Simkin, Whalley and Keppler.

"Whether this is their first pregnancy, or their fifth, women often worry about the health of their unborn baby.

Doctors have a range of genetic tests available to make sure the fetus is healthy.

Cristina Flores sat down with Annette Crowley, a registered nurse with Selecthealth, who is the Perinatal Care Manager.

Cristina: We should start by saying most babies and most pregnancies turn out just fine, right?

Annette: Absolutely, the majority of women who get pregnant, the pregnancies go along perfectly, and the baby is lovely, everything is fine. Only about 3% of all pregnancies have a birth defect associated with it. It's a very small percentage of all pregnancies.

Cristina: On that note, who needs to have these genetic tests while they're pregnant?

Annette: That's a good question. For the majority of women they are already seeking prenatal care, and that's great to be seeing their doctor. But for women who have had a baby who had some sort of birth defect or genetic problem, women who have a family history who have some sort of genetic problem, or women who are over age 35 are encouraged to look into genetic testing, or prenatal testing.

Cristina: And, to get these test, just talk to your doctor, right?

Annette: Yes, the nurse practitioner or doctor that you are working with has the information available and they can certainly walk women through what their risks are, and if they need to look into these tests.

For more information, head to www.babyyourbaby.org."

Originally published at: Genetic Testing During Pregnancy

Thursday, July 9, 2009

Childbirth Education

Hypnobabies.org Logo

I am all about educating and empowering expectant couples. If I were at a place in my life to teach childbirth education classes, I would absolutely love to do it. I'm not trying to convert the world into thinking that every woman should birth at home, or every woman should give birth naturally with no medication. I want women to educate themselves about pregnancy and birth. Learn about the whole process, about your body and the changes you will go through. Learn about your baby and its development and growth. Learn about your partner and how he/she can support you in labor and birth, and how you can grow together to embrace the changes in your lives. Learn about your care and birth options, so that YOU can take control of your care and make the best decisions for you.

I found a nice little article in ezine articles that talks about some of the benefits of childbirth classes:

You Don't Really Need That Childbirth Class, Or Do You?

I'd like to also list some childbirth education resources. I'm sure I'm missing some, but these are some of the big ones I could think of right now:

Lamaze International
The Bradley Method
Hypnobirthing
Hypnobabies

You may also be able to find childbirth classes available through your local health department, or even through a local hospital or clinic. Please keep in mind that childbirth classes sponsored by a hospital or doctor's office is more likely to have biased information because they are using the classes to promote their particular venue (hospital or clinic, etc.). Any education is better than none, however, so if your options are limited don't let that keep you from attending a class. Many childbirth educators will also offer online instruction as well, so if you are in an area where you don't have access to local classes, please look into that option.

Monday, July 6, 2009

Cloth Diapers I've Sewn

I've been using cloth diapers for over a month now, and I love them. I've also been doing research and figuring out the best pattern to use for sewing my own cloth diapers so I can build up my diaper stash. I've posted about cloth diapers twice before: All About Cloth Diapers and More About Cloth Diapers, so I won't go into great detail here about cloth diapers, but I would like to share photos and a little info about what I've been doing to make my own.

I use prefold diapers (basic flat diaper with a thick section in the middle for added absorbency) in waterproof covers. I haven't sewn any prefolds of my own yet, but I have some cotton flannel material I plan to use for that.

I based my diaper cover pattern on Rita's Rump Cover pattern. I chose this pattern for two main reasons: maximum adjustability to fit most children, infant to toddler age so I don't have to make different sizes for my different sized children, and the nice trim fit of this diaper.

I made some alterations to the pattern to fit my needs, including adding touch tape to avoid using diaper pins, removing the front wings, and folding the front and back over to help hold in a prefold diaper.
Here is the diaper cover by itself, inside view, ready to be stuffed with a prefold diaper. The green part is PUL fabric, especially designed to be waterproof. I used cotton flannel on the top to conserve my PUL where it wasn't needed, and to add some color to the cover.
Here is the cover stuffed with a medium size prefold diaper
You can see where I've added long strips of touch tape for maximum size versatility. Hook tape on the front, and loop tape on the inside of each wing.
I also added hook touch tape to the outside of one wing so the wings can stick to each other for a secure fit, and hopefully to avoid drooping or having my kids take their own diaper off. I've had problems with drooping with some of the retail covers I've tried.
This is the front of the diaper, stuffed and closed.
And here is the back. The back panel is key for size versatility. For a toddler, just put the diaper on as is, and for a younger child simply fold down the top back of the cover to create a lower rise to fit the baby.
Here is a photo of my 3 1/2 year old wearing the diaper. Notice that the wings don't overlap because of his size.
The backside of my big boy. The flannel panel isn't folded down at all for him.
A side view. Notice how trim the diaper is.
This is the same size diaper on my 18 month old. Notice how much the wings overlap on her, and it still fits her snug. I used a different piece of flannel when I made this cover, but everything is the same as the diaper my son is wearing. She had been wearing this diaper all night and I took the photo first thing in the morning, so it was very full at this point.
Here is a back view of the diaper on my 18 month old. The back flannel panel has been folded down to fit her nicely. She wouldn't hold still for me to take a side view.

I'm really enjoying using and making cloth diapers. I look forward to using them on my infant soon!

Thursday, July 2, 2009

Birth Matters Virginia Educational Video Contest Winners

Back in February I blogged about an Educational Childbirth Video Contest conducted by Birth Matters Virginia.

I'm happy to announce that the video contest is over and the winners have been announced!

Click here to view the contest results

There are links to all the winning videos, as well as the other finalists. Please take some time to watch these wonderful films.

Monday, June 29, 2009

My Baby is Coming Soon! My Feelings and Preparations.

My baby's due date is approaching soon. I have two due dates; one based on the first day of my last menstrual period, and the other is based on an ultrasound that was done at 20 weeks gestation. The ultrasound date is 11 days later than the other, and I know that estimated due dates are not always accurate, so we are awaiting the arrival of our baby whenever he decides it's time to come. My obstetrician also admitted to me that ultrasound dates aren't very accurate at 20 weeks, and if we had done an ultrasound earlier, say around 9 weeks, it would have been much more accurate. When someone asks me when the baby is due, I just say "sometime in July". I get some pretty funny looks from them when I don't give an exact date, but I'd rather not focus on a specific day and get myself worked up about it.

My first baby was born 2 days past the due date. My last 3 babies were each born 4 days before the due date. If the pattern holds true with this baby, then I will have a new baby in less than a week! I'm not focusing on that however, and I'm happy to wait until the baby is ready.


We are busily preparing ourselves for his arrival, and we're very excited to be so close to welcoming a new child into our family. We have still been unpacking from our move a few months ago, and we only have a few boxes left to go through. It feels good to be organizing our home and staying busy. I'm especially excited that we're also preparing our home to have the birth take place here. I feel great peace about my decision to birth at home, and I feel ready for the birth.


My midwife gave me a birth kit that she put together with some essentials, such as chux pads (the absorbent pads used in hospitals to catch all the fluids and yucky stuff from the birth - I never knew before that you can buy them from the local store!), latex gloves, cord clamp, herbs for sits baths (for healing after the birth), suction catheter (just in case), gauze pads for cord care after the birth, and more. She told me that most births don't require everything in the kit, but it's better to have more than you need than not enough.


She also gave me a list of things to have on hand for the birth, including: feminine hygiene pads, diapers, towels, wash cloths, sheets, shower curtains (to use under the top bedsheet and under the birthing tub), garbage bags, paper towels, wipes, ice and bowl, crock pot (to hold and keep warm compresses) baby clothes, birth food for mom and everyone who will be there, lots of juice, and ingredients for her wonderful cayenne drink (which she uses to reduce bleeding). Anything else that may be needed for the birth will be brought by the midwife and her attendants, including the birthing tub.


My midwife has several attendants training under her, and I've met tham all. I don't have a specific preference of which attendants come to the birth, so we decided that when the time comes she will call them all and see who is available to come. We could have 2 or more attendants along with our midwife, and I feel good about that, knowing I'll have lots of support along with my husband (who is a wonderful support for me during labor and birth).

My husband has been more involved in preparing the house for this baby, and I think it's because the baby will be born here. I know that he's looking forward to not having to drive to and from the hospital. We're also glad that I won't be separated from the kids for 2 or more days like I was when I gave birth in the hospital. Our youngest is only 18 months old, and I know she'll be happier having me home rather than away from her for such a long time. I feel happy knowing that I will be able to control the atmosphere at the birth, and have all the comforts of home close at hand, and be away from the hustle and chaos of the hospital. I'm really excited about laboring and possibly delivering the baby in the tub (which no hospital in my state will allow)
, and not feeling like I'm under pressure to perform according to hospital protocol.

When talking about home birth, many people ask about the possibility of something going wrong. Many are afraid of the "what ifs" of birth, and worry that they should be in the hospital "just in case". I have not had any fear about these things. I feel comfortable knowing that 95% of pregnancies and births are low-risk and require no intervention. I've had excellent prenatal care from my midwife throughout the pregnancy, and have not had any complications so far. I will also be surrounded by a team including my midwife (who has 15 years experience with home birth) and her attendants, and they will support me and watch for any possible complications. They know how to handle many surprises at home, and if something more serious were to happen, they would know when a transfer to the hospital may be needed.

All in all, this pregnancy has been wonderful and I'm a little sad for it to be ending, but more overwhelmingly excited to be welcoming a new beautiful baby into our family and home. My family is the most important thing in my life, and I would not trade this life for anything else!

Friday, June 26, 2009

Kasie's Story of Her Unassisted Water Birth

The unassisted home waterbirth of Nikolai Francis~5/5/09

I knew I would be meeting my baby that day around 6:30 a.m. That's when the contractions started coming regularly. It was still early labor, so I was able to get Gabriel and Joseph off to school, and finish up some things around the house. I put in a load of laundry, and swept the floor. Once the boys left for school, around 8:00, Stephen and I got in the shower and I started to have more intense contractions, but still not too bad. We had been planning on going grocery shopping that day, and I briefly contemplated going along, since I'm kind of particular about certain things that I like to buy, but I quickly thought better of it. The contractions were coming faster, every 6-7 minutes, and stronger. This was around 9:30. Stephen, Bobby, and Persephone left for the store at that point. I did the dishes, because I knew that would be the last thing I would want to think about once he was here!

The birth pool was already inflated, so when I was done with the dishes, I started filling it. The water felt amazing! The hardest part was having to get out of the pool and walk to the kitchen to shut the water off when it went cold. I was on my hands and knees to keep my belly underwater, since it hadn't filled enough yet. I was having intense contractions at that point, breathing and moaning through them. Stephen and the kids got home around 10:30, and he was back and forth between checking on me, getting the kids settled, and putting groceries away. Once we had hot water again, he finished filling the pool. I lost track of time around then.

I stayed in the pool for awhile, and started to feel the urge to push. It wasn't constant, so I just went with it, and did what my body was telling me to. I reached in and felt my bag of water bulging, and the baby's head. What an awesome feeling! I continued to push when I felt like it, but after awhile of the baby not coming down at all, I was getting frustrated, and hot from being in the water. Stephen spread some blankets on the bed, opened the window, and helped me out of the pool. The cool air felt good, and I continued to moan through the contractions, pushing when I felt like it, and taking full advantage of the rest in between. In those few short minutes in between contractions, I felt like I was in another world, totally removed from everything around me.

I had expected my water to break on its own, but it hadn't, and it didn't feel like I was making any progress bringing him down. On top of that, I was experiencing very intense back labor, which led me to think that he was posterior (face-up), with the hardest part of his head pressing against my spine. I told Stephen if he did nothing else, I needed him to lay into my lower back, to put all of his weight into it. I told him not to worry about hurting me. The counter pressure was the only thing that brought any relief. I started to get cold then, so I climbed back into the pool. I alternated between moaning and being completely silent with each contraction.

I felt my water bulging again, but couldn't feel the baby's head anymore, so we decided to break it on our own. Stephen sterilized a pair of fingernail clippers and tried to do it himself, but said he couldn't feel what he was doing. I took the clippers, reached inside, pricked the sac, and immediately felt the fluid rushing out. I was on my hands and knees, so I asked Stephen if it was dirty or not, and he said no. All of a sudden, I felt a massive urge to push, and went with it. In between urges, I'm telling Stephen to get the video and digital cameras ready. I remember saying "He's coming, he's coming". and Stephen asking me if he was crowning yet. I was still on my hands and knees, but flipped over when I felt his head crowning. I eased his head out, and what a wonderful feeling! Once his head was born (he was face down, so he must have turned in the birth canal), I checked for a cord around his neck, but there was none. I was just in awe as I held his head in my hands. He was between worlds. His shoulders came in another few pushes, and his body just slid out. There was no pain in the actual pushing, crowning, and birth of his body. It felt good and such a relief!

I brought him up to my chest, and just wept. I'm crying as I type this. As much as I planned and hoped for a wonderful birth experience, I could never have imagined something so beautiful. There are no words to do it justice. I will carry this experience with me for the rest of my life, hold it close to my heart, and be forever thankful that I was able to bring my son into the world in such a peaceful, gentle way.

Tuesday, June 23, 2009

The Rights of Childbearing Women

I always talk about how important it is to educate yourself about your options and your rights. This will hopefully clarify what those rights and some options are. I ran across this blog by Doula Momma that lists 20 rights of childbearing women.

This article originally appeared on The Childbirth Connection. Please refer to their article for a list of resources and if you want more information.

"The Rights of Childbearing Women
This statement outlines a set of basic maternity rights that Childbirth Connection has identified and promotes for all childbearing women. It applies widely accepted human rights to the specific situation of maternity care. Although most of these rights are granted to women in the United States by law, many women do not have knowledge of their maternity rights.

Fundamental Problems with Maternity Care in the United States
This statement was developed in response to serious and continuing problems with maternity care in the United States, including:
  • The United States is the only wealthy industrialized nation that does not guarantee access to essential health care for all pregnant women and infants. Many women, especially those with low incomes, lack access to adequate maternity care.
  • A large body of scientific research shows that many widely used maternity care practices that involve risk and discomfort are of no benefit to low-risk women and infants. On the other hand, some practices that clearly offer important benefits are not widely available in U.S. hospitals.
  • Many women do not receive adequate information about benefits and risks of specific procedures, drugs, tests, and treatments, or about alternatives.
  • Childbearing women frequently are not aware of their legal right to make health care choices on behalf of themselves and their babies, and do not exercise this right.
We must ensure that all childbearing women have access to information and care that is based on the best scientific evidence now available, and that they understand and have opportunities to exercise their right to make health care decisions. Women whose rights are violated need access to legal or other recourse to address their grievances.

The Rights of Childbearing Women
* At this time in the United States, childbearing women are legally entitled to those rights.
** The legal system would probably uphold those rights.
  1. Every woman has the right to health care before, during and after pregnancy and childbirth.
  2. Every woman and infant has the right to receive care that is consistent with current scientific evidence about benefits and risks.* Practices that have been found to be safe and beneficial should be used when indicated. Harmful, ineffective or unnecessary practices should be avoided. Unproven interventions should be used only in the context of research to evaluate their effects.
  3. Every woman has the right to choose a midwife or a physician as her maternity care provider. Both caregivers skilled in normal childbearing and caregivers skilled in complications are needed to ensure quality care for all.
  4. Every woman has the right to choose her birth setting from the full range of safe options available in her community, on the basis of complete, objective information about benefits, risks and costs of these options.*
  5. Every woman has the right to receive all or most of her maternity care from a single caregiver or a small group of caregivers, with whom she can establish a relationship. Every woman has the right to leave her maternity caregiver and select another if she becomes dissatisfied with her care.* (Only second sentence is a legal right.)
  6. Every woman has the right to information about the professional identity and qualifications of those involved with her care, and to know when those involved are trainees.*
  7. Every woman has the right to communicate with caregivers and receive all care in privacy, which may involve excluding nonessential personnel. She also has the right to have all personal information treated according to standards of confidentiality.*
  8. Every woman has the right to receive maternity care that identifies and addresses social and behavioral factors that affect her health and that of her baby.** She should receive information to help her take the best care of herself and her baby and have access to social services and behavioral change programs that could contribute to their health.
  9. Every woman has the right to full and clear information about benefits, risks and costs of the procedures, drugs, tests and treatments offered to her, and of all other reasonable options, including no intervention.* She should receive this information about all interventions that are likely to be offered during labor and birth well before the onset of labor.
  10. Every woman has the right to accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind.* (Please note that this established legal right has been challenged in a number of recent cases.)
  11. Every woman has the right to be informed if her caregivers wish to enroll her or her infant in a research study. She should receive full information about all known and possible benefits and risks of participation; and she has the right to decide whether to participate, free from coercion and without negative consequences.*
  12. Every woman has the right to unrestricted access to all available records about her pregnancy, labor, birth, postpartum care and infant; to obtain a full copy of these records; and to receive help in understanding them, if necessary.*
  13. Every woman has the right to receive maternity care that is appropriate to her cultural and religious background, and to receive information in a language in which she can communicate.*
  14. Every woman has the right to have family members and friends of her choice present during all aspects of her maternity care.**
  15. Every woman has the right to receive continuous social, emotional and physical support during labor and birth from a caregiver who has been trained in labor support.**
  16. Every woman has the right to receive full advance information about risks and benefits of all reasonably available methods for relieving pain during labor and birth, including methods that do not require the use of drugs. She has the right to choose which methods will be used and to change her mind at any time.*
  17. Every woman has the right to freedom of movement during labor, unencumbered by tubes, wires or other apparatus. She also has the right to give birth in the position of her choice.*
  18. Every woman has the right to virtually uninterrupted contact with her newborn from the moment of birth, as long as she and her baby are healthy and do not need care that requires separation.**
  19. Every woman has the right to receive complete information about the benefits of breastfeeding well in advance of labor, to refuse supplemental bottles and other actions that interfere with breastfeeding, and to have access to skilled lactation support for as long as she chooses to breastfeed.**
  20. Every woman has the right to decide collaboratively with caregivers when she and her baby will leave the birth site for home, based on their conditions and circumstances.**
1999, 2006 Childbirth Connection

Saturday, June 20, 2009

AMA Resolution Would Seek to Label “Ungrateful” Patients as "Non-Compliant"

I just came across this article regarding a proposed AMA medical billing change that could affect expectant parents' rights to take charge of their prenatal care by jeopardizing their ability to get insurance coverage or seek other care givers by labeling them as "non-complaint". Under this proposed change, I could be labeled as non-compliant by my obstetrician's office simply for not subscribing to the suggested routine of prenatal visits (because I've been doing those with my midwife instead) and choosing not to participate in certain prenatal tests and screens. I would hate for my personal choices in managing my prenatal care to impact my future care options. I've posted the article in its entirety.

Please go to the International Cesarean Awareness Network website to see what you can do to help affect a positive change. I've posted the ICAN article in its entirety:

AMA Resolution Would Seek to Label “Ungrateful” Patients
Redondo Beach, CA, June 11, 2009 - At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1)

The resolution complains:


“The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.”


“This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).


If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.


Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation.


A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.


The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:
  • Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients
  • Use of these labels fails to recognize patients as competent partners with physicians in their own care
  • Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion
  • Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers
The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.


Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery.
  1. Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients”
  2. Evidence-Based Maternity Care: What It Is and What It Can Achieve
  3. http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans

Wednesday, June 17, 2009

The Importance of Prenatal Health Care

Prenatal health care is very important. I found an article in my local news that talks about this:
I'd like to point out that an expectant mother has the option of going to an obstetrician or a midwife, and the medical care should be adequate from both sources. Both obstetricians and midwives do a urinalysis at each prenatal visit to screen for possible health concerns or complications, as well as check the mother's blood pressure, fundal height measurement, weight gain or loss, and check the baby's heartbeat.

A good obstetrician or midwife will also take time at each visit to talk with the expectant mother about her feelings, her life situation and stressors which might impact her well-being during her pregnancy.


Health care may differ from one care giver to another depending on that caregiver's approach to pregnancy and birth. Obstetricians and Certified Nurse Midwives who practice under the supervision of an OB may be more likely to take a very medical approach by suggesting more screenings and tests than a Certified Professional Midwife or Direct Entry Midwife would. Doctors approach pregnancy and birth as a problem waiting to happen. They spend more time looking for problems, because they are trained to handle emergencies and complications. Midwives generally approach pregnancy and birth by looking at the woman as a whole being and trusting in her body's ability to do what it's designed to do, and less time looking for problems. With this being said, midwives are trained to watch for potential problems and how to handle them if they do come up.

Whether you choose a doctor or a midwife for your prenatal care, and whether you choose to birth in a hospital, birth center or at home, please get the prenatal health care that you need. Learn about the screenings and tests and procedures so that you can make educated decisions about your health care. Remember that the doctor or midwife works for you, and not the other way around.